British journal of anaesthesia
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Achieving good health outcomes for patients is the fundamental purpose of healthcare. What really matters to patients is the outcome of an intervention and the effect it will have on their wellbeing and life expectancy. After media coverage, and public enquiry into high mortality rates for paediatric cardiac surgery at the Bristol Royal Infirmary during the early 1990s, mortality rates for paediatric cardiac surgical procedures decreased dramatically both in Bristol and nationally. ⋯ There are issues around clinical coding, risk adjustment, the influence of clinical teamworking, and environmental factors. The National Institute of Academic Anaesthesia (NIAA) has identified that the description of clinical practice in anaesthesia and perioperative medicine is currently limited by a lack of valid, reliable quality measures. The NIAA suggests that there is a requirement for further research into identifying the anaesthetic outcome indicators which are most relevant to patients, and then benchmarking the performance of anaesthetic departments and anaesthetists.
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Anaesthetic training in the UK has recently experienced significant organizational and politically driven changes. This article examines the effects these changes may have had on the training of anaesthetists and concludes that despite the introduction of changed working patterns and reduced hours over the past decade, academic and professional standards appear to have been maintained, but at the expense of reduced confidence among some trainees. ⋯ While this is clearly important, it understates the added value of consolidation and experience based on repeated exposure. Trainer and trainee surveys suggest that due to perceived service pressures, and worries about patient safety or clinical governance, this important latter stage in professional development is increasingly being omitted from the training programme.
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The decision of where to start a research project has been influenced by many factors over the years. Tradition has a large impact, but the individual researchers' or clinicians' personal interest has also played a major role. The pharmaceutical industries' interest has without doubt initiated and sponsored many projects in order to get new products onto the market. ⋯ One way of 'mapping' the evidence in order to find out what we know and what we do not know is the production of systematic reviews. Although systematic reviews are considered top of the evidence hierarchy, they are not flawless. The aim of this article is to explain the systematic review and point to some of the challenges in the development and use of systematic reviews.
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Healthcare litigation in the UK continues to grow at an alarming rate, with claims against anaesthetists and critical care physicians increasing each year. This has led to a huge financial burden for the taxpayer and a sharp increase in professional indemnity fees for individual doctors. Although such litigation should provide valuable information to educate practitioners and reduce future similar claims, there appear to be significant barriers preventing important lessons from being learned. ⋯ By reporting outcomes of Coroners' inquests, clinical and criminal negligence cases, and referrals to the General Medical Council, it would be hoped that more explicit standards of performance could be derived. Ultimately, this may not only improve patient safety, but protect practitioners from unjustifiable claims. Finally, given the critical importance of experts in the above process, we believe that a system for professional registration and regulation should be explored to ensure that they offer accurate, representative, and unbiased opinions and have the appropriate expertise in the subject matter to be analysed.